Accountability key to future health care

First published:
March 10, 2004

Northumberland MPP Lou Rinadi was right when he said last weekend the proposed reforms by the Ontario Liberal government’s Bill 8 are a power struggle. While he says local opposition by Northumberland Hills Hospital is about hunger for power, he failed to mention his own government’s agenda to wrestle local control away. Some would also call this power hungry.

And as we have seen with other attempts by the provincial government to take away local control, the results are often painful.

The Commitment to the Future of Medicare Act, or Bill 8, is meant to inject more accountability into the provincial health care system. Hospitals would sign performance agreements in return for cash from the province. The agreements would require hospitals to meets targets on access, quality and safety in return for cash. They would be forced to hire more nurses, reduce waiting lists for cardiac care, cancer care and other procedures currently plagued with long waiting lines.

On this level, the public should be cheering. There were suspicions of line jumping in certain cases where doctors were illegally taking cash payments. Also, there were accusations of extra billing taking place. Only two weeks ago, Liberal MPP Monique Smith, parliamentary assistant to Health Minister George Smitherman, was making similar comments outside an all-party committee meeting studying bill 8.

But the Ontario Hospital Association, local hospital boards, doctors and nurses are screaming it will allow the province to step in to take all kinds of action, bypassing volunteer hospital boards, like the one in Northumberland.

Smitherman has said the powers are nothing new, and, in fact, the minister can appoint supervisors when necessary to take over hospitals.

It is nothing new for the provincial government to demand more accountability. Under the Tories, education was a prime target. Hence testing in Grade 3 and Grade 10 was introduced. This was done in conjunction with a new curriculum. The results are made public. At the same time, it removed the ability of school board to tax locally, centralizing all funding from the province.

The same is true for Ontario’s 24 colleges. Each year students and employers of recent graduates are surveyed for something called Key Performance Indicators (KPI). The questions deal with everything from the services provided by the college, to the students’ and employers’ satisfaction. A portion of the college’s funding is based on the results.

In both cases, the rationale was to bring accountability to the system.

No doubt, the Liberals want the same control over hospitals. But it is different this time. Elementary and secondary school parents were angry over skyrocketing school board taxes and a perception students couldn’t make the grade.

The same level of discontent is smoldering with frustrated patients who feel the health care system in Ontario is not working. Nobody, no matter how dissatisfied, will be willing to give up local control of hospital boards.

To some degree, the government may be acting out of frustration.
Each time there is an attempt at control, whether it was the NDP, Tories and now the Liberals, it is greeted with massive protests from doctors, nurses and the Ontario Hospital Association.

Yes, we can get an annual report from the Ontario Hospital Association, which is meant to monitor many functions of the provincial hospitals. But this kind of self-regulatory process trustworthy. Maybe it needs to be more independent. And that is what the province is looking for in Bill 8.

And what is ironic is Rinaldi would have argued for local control when he was a municipal politician. IT is amazing how the stripes of the tiger change so quickly into the spots of a cheetah.

The local hospital board is right in one sense. The power should rest in the hands of the community. However, there may be a few people in Port Hope who might want to argue this point considering what happened to the old Port Hope hospital. So local control is not perfect either.

Accountability is key and a balance must be struck. One newspaper column is not going to solve anything.

And so we find ourselves back at the beginning.

Rinaldi is right on one level. This is about accountability and power. It will be a tough balance to strike. What is more imperative than anything is the need to reform Ontario’s health care system. Unfortunately, it’s wounds need more than bandages because nothing will heal.

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